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Right arrow Transplantation - heart

Eur J Cardiothorac Surg 2007;32:457-461. doi:10.1016/j.ejcts.2007.05.015
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Heart transplantation in patients with extreme right ventricular failure

Ron-Bin Hsu, Fang-Yue Lin*, Nai-Kuan Chou, Wen-Je Ko, Nai-Hsin Chi, Shoei-Shen Wang

Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC

Received 26 January 2007; received in revised form 30 April 2007; accepted 23 May 2007.

* Corresponding author. Address: National Taiwan University Hospital, No.7, Chung-Shan S. Rd. Taipei, Taiwan 100, ROC. Tel.: +886 2 2312 3456x5580; fax: +886 2 23410933. (Email: fylin1{at}ha.mc.ntu.edu.tw).

Objective: Donor shortage and improved medical treatment of heart failure increase the prevalence of patients with extreme right ventricular failure and ascites to heart transplantation. The clinical outcome of heart transplantation in these patients has rarely been reported. Here, we sought to evaluate the clinical outcome of heart transplantation in patients with extreme right ventricular failure and refractory ascites. Methods: Data were collected by retrospective chart review. Results: Between 1993 and 2005, 12 patients with extreme right ventricular failure and refractory ascites underwent orthotopic heart transplantation at the authors’ hospital. The causes of heart failure were congenital heart disease in four patients, dilated cardiomyopathy in two patients, rheumatic heart disease in two patients, coronary artery disease in two patients, and restrictive cardiomyopathy and transplant coronary artery disease each in one patient. Eight of 12 patients had previous cardiac operation. The findings of preoperative abdominal sonography were massive ascites in all patients, congestive liver in 11 patients, and probably cardiac cirrhosis in 1 patient. One patient underwent combined heart and kidney transplantations. There were six in-hospital deaths: bleeding in three patients and multiple organ failure in three patients. Major postoperative complications occurred in 10 patients: renal failure requiring dialysis in 9, bleeding requiring reoperation in 8 patients. Patients with previous cardiac operation had a higher mortality rate (5/7 vs 1/5). Conclusions: Heart transplantation in patients with extreme right ventricular failure and refractory ascites was associated with high mortality and morbidity. The presence of previous cardiac operation implied even poor prognosis.

Key Words: Heart transplantation • Right ventricular failure • Ascites






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.